International survey on esophageal cancer: part I surgical techniques

Abstract

In patients with esophageal cancer, radical surgical resection of the esophagus and surrounding lymph nodes is the only curative treatment option. Nevertheless, no standard surgical procedure exists. The aims of the present study were to gain insight into the frequencies of the various surgical techniques in esophageal cancer surgery as applied by surgeons throughout the world and to identify intercontinental differences regarding surgical techniques. Surgeons with particular interest in esophageal surgery, including members of the International Society for Diseases of the Esophagus, the European Society of Esophagology Group d'Etude Européen des Maladies de l'Oesophage and the OESO, were invited to participate in an online questionnaire. Questions were asked regarding approach to esophagectomy, extent of lymphadenectomy (LND), type of reconstruction, and anastomotic techniques. Subanalyses were performed for the surgeons' case volume per year, years of experience in esophageal cancer surgery, and continent. Of 567 invited surgeons, 269 participated, resulting in an overall response rate of 47%. The responders currently performing esophagectomies (n= 250; 44%), represented 41 countries across the six continents. Fifty-two percent of responders favor open transthoracic esophagectomy (TTE) over transhiatal esophagectomy (THE) or minimally invasive esophagectomy (MIE). THE is preferred by 26%, whereas MIE is favored by 14%. Eight percent have no preference for one approach to esophagectomy over the other. The extent of LND is most frequently the 2-field, routinely performed by 73% of surgeons. The continuity of the digestive tract is most frequently restored with a gastric conduit (85%). In open TTE, the anastomosis is routinely created in the neck by 56% of responders and in the chest by 40%. Cervical anastomoses are routinely fashioned by means of a handsewn technique by 65% of responders, while 35% favor the stapled technique. The cervical incision is predominantly performed vertically on the left side of the neck (routinely by 66%). A horizontal neck incision is routinely carried out by 19% of responders and a vertical right-sided incision by 11%. Significant differences in surgical techniques could be detected between low- and high-volume surgeons, between surgeons with <or=10 versus >or=21 years of experience, and between surgeons from different continents. In conclusion, currently the most commonly applied surgical procedure is the open right-sided transthoracic approach with a two-field lymphadenectomy, using a gastric tube anastomosed at the left side of the neck by means of a handsewn, end-to-side technique. The results of this survey provide baseline data for future research and for the development of international guidelines.

Road Map to Esophagectomy for Nurses

“…19 Continued developments in surgical and diagnostic techniques have been unsuccessful in improving the 5-year life expectancy, which remains less than 20%. 1,2,4,5,16,17 The addition of neoadjuvant therapy combining chemotherapy and/or radiation before or after surgery has become common in an attempt to create a survival advantage not provided by surgery alone. Neoadjuvant therapy could improve surgical outcomes by reducing tumor size, thus increasing the feasibility of resection, and addressing the issue of Transthoracic (Ivor-Lewis) Approach.…”

“…undetected micrometastases not found at the time of diagnosis. 5,[9][10][11]16,17 The chemotherapy used in esophageal cancer often consists of a dual-medication approach such as use of cisplatin and 5-fluorouracil. 19 The drugs are generally given through a tunneled central venous catheter or a peripherally inserted central venous catheter.…”

“…The mortality rate remains high, with a 5-year survival rate of 10% to 35% regardless of treatment management. [1][2][3][4][5] Although esophageal cancer is considered uncommon in the United States when compared with other cancers, its occurrence has increased steadily. In 2009, 16470 new cases of esophageal cancer were diagnosed and 14530 deaths due to esophageal cancer to help the patient attain an optimal quality of life.…”

“…A CT scan should include the chest, abdomen, and pelvis. 5,17 Endoscopic ultrasonography is used for better evaluation of involvement of local lymph nodes and determination of tumor penetration. Ultrasonography may be combined with fine-needle aspiration of lymph nodes for pathologic confirmation of involvement.…”

“…Endoscopy is useful for the diagnosis of cervical lymph node involvement and can be used to distinguish involvement of the esophageal wall. 5 Computed tomography (CT) is used to begin pretreatment staging by identifying involvement of regional lymph nodes and the presence of distant metastases. A CT scan should include the chest, abdomen, and pelvis.…”